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Stuart J Connolly, Michael D Ezekowitz, Salim Yusuf, John Eikelboom, Jonas Oldgren, Amit Parekh, Janice Pogue, Paul A Reilly, Ellison Themeles, Jeanne Varrone, Susan Wang, Marco Alings, Denis Xavier, Jun Zhu, Rafael Diaz, Basil S Lewis, Harald Darius, Hans-Christoph Diener, Campbell D Joyner, Lars Wallentin
BACKGROUND: Warfarin reduces the risk of stroke in patients with atrial fibrillation but increases the risk of hemorrhage and is difficult to use. Dabigatran is a new oral direct thrombin inhibitor. METHODS: In this noninferiority trial, we randomly assigned 18,113 patients who had atrial fibrillation and a risk of stroke to receive, in a blinded fashion, fixed doses of dabigatran--110 mg or 150 mg twice daily--or, in an unblinded fashion, adjusted-dose warfarin...
September 17, 2009: New England Journal of Medicine
Shelley R Salpeter, Jacob S Buckley, Eduardo Bruera
BACKGROUND: Opioid dose escalation may cause hyperalgesia, mediated by the N-methyl-D-aspartate (NMDA) pathway. Methadone is an atypical opioid that inhibits hyperalgesia through NMDA-blockade, especially at low doses. OBJECTIVE: To evaluate the efficacy of using very-low-dose methadone as the sole long-acting opioid agent in a hospice practice. DESIGN: A retrospective, observational study of the use of methadone, ≤15 mg daily, with as-needed short-acting opiates...
June 2013: Journal of Palliative Medicine
G Michael Felker, Kerry L Lee, David A Bull, Margaret M Redfield, Lynne W Stevenson, Steven R Goldsmith, Martin M LeWinter, Anita Deswal, Jean L Rouleau, Elizabeth O Ofili, Kevin J Anstrom, Adrian F Hernandez, Steven E McNulty, Eric J Velazquez, Abdallah G Kfoury, Horng H Chen, Michael M Givertz, Marc J Semigran, Bradley A Bart, Alice M Mascette, Eugene Braunwald, Christopher M O'Connor
BACKGROUND: Loop diuretics are an essential component of therapy for patients with acute decompensated heart failure, but there are few prospective data to guide their use. METHODS: In a prospective, double-blind, randomized trial, we assigned 308 patients with acute decompensated heart failure to receive furosemide administered intravenously by means of either a bolus every 12 hours or continuous infusion and at either a low dose (equivalent to the patient's previous oral dose) or a high dose (2...
March 3, 2011: New England Journal of Medicine
Mark H Ebell, MaryBeth Culp, Krista Lastinger, Tara Dasigi
CONTEXT: An annual bimanual pelvic examination remains widely recommended for healthy women, but its inclusion may discourage attendance. Our goal was to determine the accuracy of the pelvic examination as a screening test for ovarian cancer and to distinguish benign from malignant lesions. EVIDENCE ACQUISITION: PubMed was searched to identify studies evaluating the accuracy of the bimanual pelvic examination for ovarian cancer diagnosis. Data regarding study design, study quality, and test accuracy were abstracted...
March 2015: American Journal of Preventive Medicine
Edwin Choon Wyn Lim, Mathew Guo Xiang Tay
INTRODUCTION: In recent years, Kinesio tape has been used to support injured muscle and joints, and relieve pain. We compared the pain and disability in individuals with chronic musculoskeletal pain who were treated with Kinesio taping with those using minimal or other treatment approaches. METHODS: Searches of eight major electronic databases were conducted. Data for pain and disability scores were extracted. Meta-analyses (wherever possible) with either a fixed or random effect(s) model, standardised mean differences (SMDs) and tests of heterogeneity were performed...
December 2015: British Journal of Sports Medicine
Allan Gottschalk, Jessica Hubbs, Ami R Vikani, Lindsey B Gottschalk, Frederick E Sieber
BACKGROUND: The impact of delirium on survival of elderly patients remains undetermined with conflicting results from clinical studies and meta-analysis. In this study, we assessed the relationship between long-term mortality and incident postoperative delirium in elderly patients undergoing hip fracture repair. METHODS: Patients ≥65 years old who were not delirious before undergoing hip fracture repair were included in a database maintained prospectively from March 1999 to July 2009...
November 2015: Anesthesia and Analgesia
Jeffrey J Nepple, Jonathan M Vigdorchik, John C Clohisy
BACKGROUND: Femoroacetabular impingement (FAI) is recognized as a common cause of hip pain and intra-articular disorders in athletes. Studies have suggested a link between participation in athletics during adolescence and the development of cam-type deformities of the proximal femoral head-neck junction. PURPOSE: To investigate the association of sporting activity participation during adolescence and the development of cam deformity. STUDY DESIGN: Systematic review...
November 2015: American Journal of Sports Medicine
Miao Li
In this study, I used the growth curve model to examine the association between grandparents' (first generation (G1)) life-course exposure to chronic poverty and grandchildren's (third generation (G3)) body mass index (BMI; weight (kg)/height (m)(2)) growth trajectories. This association was estimated separately for male and female grandchildren. Analyses were based on prospective data from a US longitudinal survey, the Panel Study of Income Dynamics (1968-2011), and 2 of its supplemental studies: the Child Development Supplement (1997-2011) and the Transition into Adulthood Study (1997-2011)...
February 1, 2015: American Journal of Epidemiology
Fangyi Gu, Jiali Han, Francine Laden, An Pan, Neil E Caporaso, Meir J Stampfer, Ichiro Kawachi, Kathryn M Rexrode, Walter C Willett, Susan E Hankinson, Frank E Speizer, Eva S Schernhammer
BACKGROUND: Rotating night shift work imposes circadian strain and is linked to the risk of several chronic diseases. PURPOSE: To examine associations between rotating night shift work and all-cause; cardiovascular disease (CVD); and cancer mortality in a prospective cohort study of 74,862 registered U.S. nurses from the Nurses' Health Study. METHODS: Lifetime rotating night shift work (defined as ≥3 nights/month) information was collected in 1988...
March 2015: American Journal of Preventive Medicine
Diego Orbegozo Cortés, Teresa Gamarano Barros, Hassane Njimi, Jean-Louis Vincent
BACKGROUND: Positive fluid balance has been associated with worse outcomes, and knowledge of differences in the amounts of different types of fluid needed to achieve the same end points may have important clinical implications. Large molecules persist longer in the blood vessels than smaller molecules, such that less IV colloid may be needed to achieve similar hemodynamic end points compared with crystalloid. Recent clinical data have, however, challenged this physiological concept, with investigators reporting lower-than-expected crystalloid/colloid ratios in various populations...
February 2015: Anesthesia and Analgesia
Wouter A Moojen, Mark P Arts, Wilco C H Jacobs, Erik W van Zwet, M Elske van den Akker-van Marle, Bart W Koes, Carmen L A M Vleggeert-Lankamp, Wilco C Peul
STUDY QUESTION: Is interspinous process device implantation more effective in the short term (eight weeks) than conventional surgical decompression for patients with intermittent neurogenic claudication due to lumbar spinal stenosis? SUMMARY ANSWER: The use of interspinous implants did not result in a better outcome than conventional decompression, but the reoperation rate was significantly higher. WHAT IS KNOWN AND WHAT THIS PAPER ADDS: Bony decompression and treatment with interspinous process devices are superior to conservative and non-surgical treatment for intermittent neurogenic claudication due to lumbar spinal stenosis...
January 2015: British Journal of Sports Medicine
L V Gulotta, D Choi, P Marinello, T Wright, F A Cordasco, E V Craig, R F Warren
Reverse total shoulder replacement (RTSR) depends on adequate deltoid function for a successful outcome. However, the anterior deltoid and/or axillary nerve may be damaged due to prior procedures or injury. The purpose of this study was to determine the compensatory muscle forces required for scapular plane elevation following RTSR when the anterior deltoid is deficient. The soft tissues were removed from six cadaver shoulders, except for tendon attachments. After implantation of the RTSR, the shoulders were mounted on a custom-made shoulder simulator to determine the mean force in each muscle required to achieve 30° and 60° of scapular plane elevation...
December 2012: Journal of Bone and Joint Surgery. British Volume
R E Jones, R D Russell, M H Huo
Most problems encountered in complex revision total knee arthroplasty can be managed with the wide range of implant systems currently available. Modular metaphyseal sleeves, metallic augments and cones provide stability even with significant bone loss. Hinged designs substitute for significant ligamentous deficiencies. Catastrophic failure that precludes successful reconstruction can be encountered. The alternatives to arthroplasty in such drastic situations include knee arthrodesis, resection arthroplasty and amputation...
November 2012: Journal of Bone and Joint Surgery. British Volume
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